Project Summary Chronic kidney disease (CKD) is a prevalent health problem, affecting nearly 26 million individuals nationally, that is underestimated, expensive to treat, reduces productivity, length and quality of life, and occurs more frequently in lower-income, ethnic minority populations. Early CKD, which is typically asymptomatic, when left untreated, can progress to end stage renal disease (ESRD) that has devastating economic and health consequences. Identification of individuals in the early stages of kidney disease is crucial, particularly for communities at high risk, such as African American (AA) adults. AA have a fourfold increase in CKD risk compared to Whites, a 3 to 4 fold increase in kidney failure, and higher hospitalization rates and progression to ESRD than Whites. Early stage CKD is asymptomatic; however, due to the high financial and health costs of CKD and progression to ESRD, screening, identifying, and protecting kidney health in the early stages is critical. Preliminary studies by the PI have found that the addition of fruits and vegetables (F&V) to the diet can preserve kidney function in individuals with CKD. Adding F&V to the diet is a relatively low-cost and scalable intervention, which can be implemented by local communities. The Diabetes Health & Wellness Institute (DHWI), a community and population health center and research entity of Baylor Scott & White Health, is uniquely positioned to evaluate a community-based CKD intervention due to its strong community partnerships and location in a low-income, primarily ethnic minority community with elevated rates of CKD, and its successful provision of F&V through community-based farm stands. This study allows DHWI to leverage its unique position and preliminary work to evaluate a scalable population health model to 1) screen, 2) identify, and 3) intervene with individuals at highest risk of CKD and progression to ESRD that could be implemented in other high risk communities and health care systems. ?Fruit and Veggies for Health? is a prospective, randomized two group study to evaluate a community-engaged screening, identification, and F&V intervention to improve CKD outcomes in 140 AA adults (>18 years of age). Participants will be randomized to either a 1) fruit and vegetables only (F&V Only) or 2) fruit and vegetables plus a nutrition/cooking program (F&V + Cook). The aims of this study are to evaluate the feasibility and initial efficacy of a population health approach to provide access to F&V, with and without cooking education, on F&V intake, urine angiotensinogen (AGT; primary surrogate marker of eGFR), albumin-to-creatinine ratio (ACR), lipoproteins, blood pressure, hemoglobin A1c, and body mass index in 140 AA adults at risk for CKD progression to ESRD. Determining whether additional components, such as cooking education, improve programs to increase F&V intake and CKD risk are needed to develop evidence-based population health approaches for our highest risk populations.